Heterogeneity in practice during negative scrotal exploration for clinically‐suspected testicular torsion

Abstract

AimDiagnostic uncertainty, inadequate training and inexperience could lead to surgeons performing unnecessary orchidopexy during negative scrotal exploration for suspected testicular torsion. In the present study, we aimed to examine current practice, in order to highlight areas for improvement and focused guideline recommendations.Patients and MethodsPatients undergoing scrotal exploration for suspected torsion at a UK hospital from 1 August 2012 to 1 July 2013 were included. Urologists managed patients over 16 years of age, and general surgeons managed those 16 years and younger. Demographic and admission details, diagnosis, surgical technique and specialty of the surgeon were recorded. Diagnosis and management of torsion and nontorsion were examined. Negative scrotal exploration was defined as the absence of testicular torsion.ResultsThere were 73 emergency scrotal explorations. The median age was 17 years. Urologists operated on 52 per cent. A total of 34 per cent of adult and 26 per cent of paediatric patients had an intraoperatively‐confirmed diagnosis of torsion (P < 0.01). Fifty two of 73 (70 per cent) patients had negative scrotal exploration, of which 29 of 52 (56 per cent) underwent ipsilateral orchidopexy, and seven of 52 (13 per cent) underwent contralateral orchidopexy. General surgeons performed nonindicated orchidopexy more than urologists (P < 0.001).ConclusionVariations in practice exist between surgeons managing negative scrotal exploration. Although appropriate emphasis during training is placed on managing testicular torsion, attention must also be given to consensus management of negative scrotal exploration.